The further we go, the more often we question the methods of treatment, which are largely based on “folk therapy”. But there are more questions than answers to them.
Patients and doctors should know that medical treatments are safe and effective, but it’s no secret that not all medical treatments, including those that are commonly used, are safe and effective. For example, antiarrhythmic drugs were widely prescribed in the hope that they would reduce mortality from heart attacks, until clinical trials showed that they actually increased the risk of death.
In another example, it was recommended to put babies to sleep on their stomachs, based on experts’ opinion that infants are less likely to choke on vomiting, until large studies showed that sleeping on their stomachs increases the risk of sudden infant death syndrome. How then to act in this case, if not all the recommendations of doctors are actually effective?
Problems of modern therapy
In the early 2000s, researchers estimated that the effectiveness of only 25%-50% of treatment methods is confirmed by high-quality studies. But these estimates are now outdated, since, in particular, they used methods of analysis rejected today. More recently, in 2020, a more rigorous assessment was published, according to which only 10% of medical treatments were based on high-quality evidence. However, this estimate was based on a small sample of 151 studies.
Meanwhile, some continue to insist that most treatments should work. How else can we explain that we live ten years longer than our great-grandparents? However, the increase in life expectancy is due, at least in part, to public health measures such as clean water, better nutrition and a reduction in the number of passive and active smokers.
To resolve disputes about the proportion of treatments based on reliable evidence, an international team of researchers from the UK, USA, Switzerland and Greece conducted a large study of 1,567 medical procedures. The sample included all treatment methods tested in Cochrane reviews in the period from 2008 to 2021. Cochrane’s reviews are studies that combine all available relevant data on treatment methods. They are often referred to in national and international health guidelines.
The study showed that 95% of treatments do not have high-quality evidence to support their benefits. Worse, harm is reported only in about 33% of Cochrane reviews. Of particular concern is that the harm from medical interventions is rarely quantifiable. In order for a doctor or patient to decide whether to use a treatment, they need to know whether the benefits outweigh the harm. If harm is measured inadequately, an “informed choice” is impossible. Thus, if you are faced with the choice of a treatment method for a disease, preference should be given to those who have evidence of their effectiveness, or at least have an adequate assessment of possible harm.